EmailMe Form - STUDENT UPDATE REQUEST

Master Instructor Verification Code: *

Student Name *

First Last

Update on Work with Student: *

Question Notes: Please provide specific information regarding your progress with the child, as it relates to the following: Is it easy to schedule and keep appointments? Is the home supportive and receptive of educational assistance? Are the visits regular and frequent? Is the youth working on relevant material, and cooperating with you during sessions? Is the youth fully engaged with you and happy to be with you during sessions? Are the youth's grades and/or documented educational progress support your findings? Do you have any recommendations to our team's approach to provide educational services?

Please check the box next to each of the statement below if it TRUE: *

(1) The student is CAPABLE of learning and VERY WILLING to learn.

(2) The Home-Decision Maker (HDM) has been VERY SUPPORTIVE in getting the student educational assistance services.

(3) When needed and If needed, the Case Worker has been ACTIVELY INVOLVED in getting sessions set up.

None of the statements above is true.

Notes: (A) If ANY of the first THREE BOXES are checked, this means that the FOURTH box should be UNCHECKED; (B) For the THIRD question relating to the case worker, this depends on whether there were scheduling problems AND the case worker duly intervened. If there was no intervention, then the box should be checked by default.